Computed tomography findings of the bony portion of the Eustachian tube with or without patulous Eustachian tube patients

CT Imaging of Eustachian Tube Balloon Dilation: Method Development on Cadaver Heads

Objective: To develop a methodology for the measurement of balloon dilation (BD) effects on Eustachian Tube (ET) structure using Computerized Tomography (CT) images. Methods: The BD of the ET was performed on three cadaver heads (five ears) through the nasopharyngeal orifice. The axial CT images of the temporal bones were obtained before dilation, while an inflated balloon was in the lumen of ET, and after balloon removal in each ear. Utilizing Dicom images captured by the ImageJ software 3D volume viewer function, the anatomical landmark coordinates of the ET were matched with their pre- and post-dilation counterparts, and the longitudinal axis of the ET was captured with serial images. The histograms of the regions of interest (ROI) and three different lumen width and length measurements were obtained from captured images. The densities of air, tissue, and bone were determined with histograms as a baseline to determine the BD rate as a function of increased air in the lumen. Results: The small ROI box included the area of prominently dilated ET lumen after BD and best represented the visually obvious changes in the lumen, compared to the ROIs that extended the wider areas (longest and longer). Air density was the outcome measure for comparison with each corresponding baseline value. The average increase in air density in the small ROI was 64%, while the longest and long ROI boxes showed 44 and 56% increases, respectively. Conclusion: This study describes a method to image the ET and quantify the outcomes of BD of the ET using anatomical landmarks.

Trans-tympanic insertion of an angiocatheter with a stopper for treatment of patulous Eustachian tube

BACKGROUND

Plugging of the Eustachian tube (ET) is an effective method for treating patulous Eustachian tube (PET). However, no material suitable for plugging is commercially available. A plugging material was made using an angiocatheter and a ventilating tube (VT).

METHODS

An 18-gauge angiocatheter was cut 25 mm from the tip, and the cut end was occluded and widened by melting using a candle. The angiocatheter was inserted into the hole of a Paparella type 1 VT, which was moved to the cut end of the catheter. The VT acted as a stopper at tympanic orifice of ET to prevent the angiocatheter from descending into nasopharynx. Two women with PET received ET-plugging surgery using this plugging material via trans-tympanic approach.

RESULTS

All symptoms of PET disappeared after surgery. There have been no postoperative complications, and the catheter has functioned well without extrusion.

CONCLUSION

A plug created from an angiocatheter and a VT is easy to make and is effective for the treatment of PET.

Evaluation of the relationship of chronic otitis media with the Körner's septum, auditory tube angle, and tubotympanic angle

PURPOSE

This study aimed to evaluate the relationships between chronic otitis media (COM) and the characteristics of Auditory tube (Eustachian) angle (ATa), tubotympanic angle (TTa), and Körner's septum (KS).

METHODS

A retrospective research was conducted between January 2019 and October 2019. The computed tomography (CT) results and medical files of 210 patients were evaluated. According to CT results and medical files, the patients were evaluated regarding the presence of COM, KS, ATa, and TTa.

RESULTS

There were 113 (53.81%) males and 97 (46.19%) females in the study group, and the mean age of the patients was 42.05 ± 10.77 years. The frequency of the KS was significantly higher in patients who were diagnosed with COM (35.66% vs. 7.41%, p < 0.001). The patients diagnosed with COM were found to have a narrower ATa and a wider TTa than the patients who were not diagnosed with COM. ATa was narrower and TTa was wider in patients with KS. The presence of KS and higher TTa value were considered as risk factors for COM (p < 0.001, p < 0.001, respectively) CONCLUSION:  Our findings indicate that ATa was narrower, TTa was wider and KS was more frequent in patients with COM. Analysis of risk factors demonstrated that increased TTa and the presence of KS were associated with increased risk for COM.

Novel Radiologic Approaches for Cholesteatoma Detection: Implications for Endoscopic Ear Surgery

Technological advancement in computed tomography (CT) and MRI has improved cholesteatoma detection rates considerably in the past decade. Accurately predicting disease location and extension is essential for staging, planning, and preoperative counseling, in particular in the newer approach of endoscopic ear surgery. Improved sensitivity and specificity of these radiological methods may allow the surgeon to confidently monitor patients, therefore avoiding unnecessary surgery. This article outlines recent advances in CT and MRI technology and advantages and disadvantages of the newer techniques. Emphasis on improving the feedback loop between the radiologist and surgeon will increase the accuracy of these new technologies.

Management of Patulous Eustachian Tube

Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET’s abnormal patency. It may lead to an enormous reduction in quality of life. Various treatment methods, including conservative and surgical therapy, have been reported. In most cases, conservative treatment is sufficient to relieve patients of aural symptoms. However, some chronic and severe cases are resistant to traditional conservative therapy. Recently performed prospective and multicenter trials revealed the efficacy and safety of a silicone plug (Kobayashi plug) insertion for patients with severe PET. Patulous Eustachian tube handicap inventory-10 (PHI-10), tubal obstruction procedures, sitting computed tomography (CT), and ET function tests (tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry) are useful for diagnosis as well as selecting candidates for surgery in severe cases.

Plug size selection protocol for the treatment of intractable patulous Eustachian tube with Kobayashi Plug

Background: There have been no useful criteria for initial plug size selection protocol for the treatment of intractable patulous Eustachian tube (PET). Aims/objectives: To establish a method for appropriate plug size selection using tubal function test and subjective symptom severity in PET patients who were treated by Kobayashi Plug insertion. Material and methods: A retrospective survey of medical records identified 39 ears of 35 patients with PET who received insertion of the Kobayashi Plug and whose PET symptoms were thereafter controlled for at least 6 months after surgery. Method: The evaluation scale of PET handicap inventory-10 (PHI-10) was used to indicate PET subjective symptom severity. Tubal function tests (sonotubometry and tubo-tympano-aerodynamic-graphy: TTAG) were performed. Results: There was no correlation between the preoperative PHI 10 score and plug size (p = .157). There was a significant correlation between the preoperative sound attenuation from nostril to EAC measured by sonotubometry and plug size (p < .001). There was no correlation between the preoperative pressure transmission ratio estimated by TTAG and plug size (p = .271). Conclusions and Significance: Sonotubometry which evaluates sound attenuation from nostril to EAC can be a useful tool for selecting plug size.

The efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube patient

OBJECTIVE

To assess the efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube (PET) patients.

METHODS

A prospective survey of medical records identified 36 patients and 47 ears with PET, and 15 patients and 15 ears as control. The ETDQ-7, patulous Eustachian tube handicap inventory-10 (PHI-10) and Likert scale were evaluated. PET patients were divided into two groups based on severity of symptoms using the PHI score.

RESULTS

The Cronbach α value of the PET group was 0.765. The average total score of the ETDQ-7 in the control group was 7.6 ± 1.1 and 22.5 ± 10.0 in the PET group (p < .01). No correlation was found between ETDQ-7 and Likert scale (r = 0.248, p = .09). The average total score of the ETDQ-7 in the mild or moderate PET group was 19.9 ± 9.0 and 25.3 ± 11.1 in the severe PET group and this was not statistically different (p = .08).

CONCLUSION

The highest ETDQ-7 score was also observed in PET patients and in ET dysfunction patients. These findings necessitate careful discrimination between ET dysfunction and PET in balloon dilation Eustachian tuboplasty (BET) based on ETDQ-7.

A Novel Imaging Method for the Cartilaginous Eustachian Tube Lumen: Computerized Tomography During the Forced Response Test

OBJECTIVES

In vivo imaging of the open cartilaginous Eustachian tube (ET) lumen by computed tomography (CT) scan during ET function (ETF) testing to establish new methodology.

METHODS

Five adults underwent unilateral ETF testing of an ear with a nonintact tympanic membrane using the forced response test (FRT) to measure the opening pressure (PO), steady state pressure (PS), and flow conductance (CS). Then at baseline and during the PS phase of the FRT, a temporal-bone CT scan with continuous 0.625 mm thickness was obtained. Multiplanar oblique reformats along the axis of the ET were created, and point value and region of interest (ROI) Hounsfield unit measurements were recorded from the location of the ET lumen.

RESULTS

At the FRT flow rate of 11 ml/min, the average PO, PS, and CS were 370.5 daPa, 119.6 daPa, and 0.16 ml/min/daPa, respectively. For flow rates of 23 and 46 ml/min, these values were 236.2, 204.2, 0.12 and 385.5, 321.1, 0.18, respectively. Although areas with lower attenuation were suggestive of air density, a distinct air-filled cartilaginous ET lumen could not be confirmed.

CONCLUSIONS

While the current imaging parameters failed to resolve the air-soft tissue interface throughout the open cartilaginous ET, further advances in imaging may obviate this limitation.

Diagnostic criteria for Patulous Eustachian Tube: A proposal by the Japan Otological Society

Patulous Eustachian Tube (PET) is of increasing importance in otology. However, despite the abundance of diseases requiring a differential diagnosis from PET, such as superior semicircular canal dehiscence syndrome, perilymphatic fistula, acute low-tone sensorineural hearing loss, etc., there are currently no established diagnostic criteria for PET. In view of these circumstances, the Japan Otological Society (JOS) Eustachian Tube Committee proposed the diagnostic criteria for Patulous Eustachian Tube in 2012, in order to promote clinical research on PET. A revision was made in 2016, maintaining the original concept that the criteria should be very simple, avoid any contamination of "Definite PET" with uncertain cases. Moreover, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings ("Possible PET"). The criteria can be used by all otolaryngologists even without using the Eustachian tube function test apparatus. However, the use of such an apparatus may increase the chances of detecting "Definite PET". The algorithm for the diagnosis of PET using the criteria has also been described. The JOS diagnostic criteria for Patulous Eustachian Tube will further promote international scientific communication on PET.